The State of Population Health Surveillance Using Electronic Health Records: A Narrative Review

Abstract

Electronic health records (EHRs) are transforming the practice of clinical medicine, but the extent to which they are being harnessed to advance public health goals remains uncertain. Data extracted from integrated EHR networks offer the potential for almost real-time determination of the health status of populations in care, for targeting interventions to vulnerable populations, and for monitoring the impact of such initiatives over time. This is especially true in ambulatory care settings, which are uniquely suited for monitoring population health indicators including risk factors and disease management indicators associated with chronic diseases. As efforts gather steam to integrate health data across delivery systems, large networks of electronic patient information are increasingly emerging. Few of the national population health surveillance systems that rely on EHR data have progressed beyond laying groundwork to launch and maintain EHR-based surveillance, but a limited number of more focused or local efforts have demonstrated innovation in population health surveillance. Common challenges include incompleteness of population coverage, lack of interoperability across data systems, and variable data quality. This review defines progress, opportunities, and challenges in using EHR data for population health surveillance.

Pertussis: Microbiology, Disease, Treatment, and Prevention

“…Existing information technology and new telecommunication systems may be leveraged to integrate case finding and communication among health care providers and public health agencies with diagnostic testing and guidance for prophylaxis and treatment that facilitates early termination of pertussis outbreaks (581). Such new-generation disease surveillance systems may be adaptable to mobile platforms, particularly in low-and middle-income countries with limited hardwire broadband capacity, and may benefit control of pertussis and many other diseases (582)(583)(584)(585)(586). Strengthened surveillance for pertussis cases among vaccinees and nonvaccinees will help shed light on the emergence and distribution of vaccine-induced escape strains of B. pertussis that may emerge in different parts of the world (510,511).…”

Can Electronic Health Records Be Used for Population Health Surveillance? Validating Population Health Metrics Against Established Survey Data

“…Data from geographically defined electronic health record (EHR) networks offer the promise of being timely and population specific. However, this promise is tempered by concerns about system governance, data quality, sampling bias, and a host of technical extraction-related issues, all of which influence both the ability to produce local prevalence estimates from EHR data and the data’s accuracy 2,3. In 2012, with support from external funders and in partnership with the City University of New York School of Public Health (CUNY), the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sought to test whether EHR data obtained from a convenience sample of more than 700 outpatient practices could be used to produce accurate estimates of population prevalence for NYC.…”

Population cardiovascular health and urban environments: the Heart Healthy Hoods exploratory study in Madrid, Spain

“…Spain has almost universal coverage of public insurance (>99 %) and we were able to ascertain that we had data on more than 96 % of the people living in the area (according to the municipal registry). The use of these systems for continuous chronic disease surveillance (see Table 4) will increase opportunities for prevention, as seen in cases like New York [36]. …”